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Background: Mozambique implemented viral load (VL) testing in June 2015, with five referral laboratories serving 11 provinces. In December 2015, VL testing expanded nationwide to all health facilities (HF) through the creation of a sample referral network. This critical expansion of services increased demand for routine VL testing, but laboratory-processing capacity did not expand at the same rate. From January 2016 - September 2016, there was a backlog of 6,000 VL samples to be processed by the Nampula referral laboratory, with the mean TAT increasing from 28 to 43 days. To address this challenge, ICAP analyzed the existing systems within this laboratory to identify gaps and design strategies to reduce TAT and increase sustainability of VL testing services.
Description: Based on the results of a TAT analysis, ICAP in coordination with the Health Authorities and the VL laboratory at Nampula Central Hospital implemented the following interventions in January 2017: 1) creation of convergence points or “hubs” for samples and results at 10 high volume HF; 2) procurement of three motorbikes to strengthen sample referral network; 3) addition of four new data clerk positions to support data entry into the laboratory information system (DISA*LAB); and 4) increased length of shifts from two to four hours for lab technicians, with associated payment for additional hours worked. Turnaround time and laboratory processing capacity were analyzed before and after implementation of the strategies to evaluate the impact of these interventions.
Lessons learned: The synergistic implementation of these strategies contributed to improvements in VL sample processing. Following implementation, TAT for VL samples was reduced from 43 to 15 days, despite a 248% increase in the number of samples processed on a quarterly basis during that same time period (Oct - Dec 2016 = 3,654, Jan - Mar 2017 = 11,262, Apr- Jun 2017 = 12,715).
Conclusions/Next steps: Through analysis of the factors affecting TAT, ICAP was able to identify and implement a series of strategies, in conjunction with regular technical support, which significantly reduced VL sample TAT. However, challenges to prompt processing of VL testing remain, including the need to further increase the number of technical staff at referral laboratories.